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Identify the three nursing care priorities using the first four steps of the Clinical Reasoning Cycle

A suggested structure of Assessment One

CLINICAL SCENARIO – We use NRSG259 Tutorial scenario Giuseppe’s situation as an example to help you understand and structure of Assessment One.

INTRODUCTION: (175 words approx.)

· Introduce the topic and any important and relevant concepts to the reader.

· Indicate the purpose of the paper

· Describe the overall plan or structure of the paper

BODY: (1400 words approx.)

Please note that the table below is to guide you to structure the body of the essay. You will need to use paragraphs to present the discussion in your assignment. The body of the essay includes Part A and Part B:

Part A – identifying three nursing care priorities
Identify the three nursing care priorities using the first four steps of the Clinical Reasoning Cycle Consideree Functional Consequences Theory – (embedded in discussion):
1. Consider the patient – describe facts and contents. This is the first stage of the clinical reasoning cycle, the nurse begins to gain an initial impression of the client’ situation.

For example:

This is an 89 old client – Giuseppe Guinta. He feels breathless on exertion, with wheezing and chest tightness. A 5 x 6x 0.2 cm ulcer is found at his right ankle, with a fair amount of exudate and an offensive smell. Giuseppe lives with his wife, Regina who experiences an intermittent memory loss, in a two- storey house…

· Age-related changes (not modifiable) such as the decreased respiratory muscle tone and efficiency; decreased number of

cilia cells; diminished chemoreceptor sensitivity to hypoxaemia; increased chest-wall compliance (Hunter, 2012, p. 434).

· Risk factors (modifiable) such as smoking, occupational exposure to respiratory toxins, living in a 2storey house, with COPD, etc. (Hunter, 2012, p. 434).

· Negative Functional

Consequences – difficulty

2. Collect cues/information – review the information, gather new information and recall knowledge;

Giuseppe had a history of smoking for

20 years, COPD for 10 years, hypertension and cardiac failure for 6 years…

Giuseppe feels tired easily and has difficulty climbing stairs and managing garden recently. His leg ulcer shows no sign of improvement. He also feels embarrassed about the smell and exudate from his leg ulcer…

performing ADLs; a risk of being socially isolated and depression.
3. Process information – to interpret, discriminate, relate, infer, match the data and predict an outcome.

· COPD – related to smoking

· Shortness of breath – related to COPD and cardiac failure…

· Leg ulcer – related to immobility, smoking, cardiac failure and


(You should expand each point with support of the literature evidence.)

4. Identify problems/issues – synthesise all the information that has been collected and processed in order to identify the most significant patient problems or issues. You only need to identify three (3) issues for this assignment.

You can conduct a literature search on your client’s issues and find relevant nursing

diagnoses for each of the identified problems. Here is a useful link for some nursing diagnoses for COPD as an example. https://nurseslabs.com/chronic obstructive  pulmonary  disease copd nursing  care  plans/

We have chosen the “Ineffective breathing pattern” as the top priority of care.

Part B: Having identified all of the nursing care priorities, choose the top priority of care and then discuss using the remaining 4 steps in the Clinical Reasoning Cycle
5. Establish goals – setting up the goal with the patient (demonstrating dignity) for the particular nursing issue. The goal should be specific measurable achievable realistic and timely(SMART).

The goals for managing ineffective breathing pattern could be:

· Giuseppe’s frequency and severity of the shortness of breath will be reduced to the level that John can tolerate within a week.

· Giuseppe will be able to climb the stairs with decreased breathlessness in one month.

You can write more goals according to the nursing issues identified.

Considering Giuseppe’s age, his pathological conditions, psychological stressors, living environment, life style, and social network, etc. throughout the clinical reasoning cycle wherever it is applicable.
6. Take action – showing your nursing interventions/strategies with the relevant rationale(s) for each intervention. E.g.

 deep breathing exercise to increase the lung expansion and

prevent pneumonia

· refer Giuseppe to GP for consideration of provision of home oxygen, bronchodilators and antibiotics;

· ADLs assessment and

organising a carer to assist Giuseppe with ADLs if needed.

· Falls’ risk assessment

(You should expand each point with support of the literature evidence. The rationale for each action should be included.)

7. Evaluate outcomes showing the expected outcomes and how you would evaluate them (objectively and subjectively). These should relate to your Goals. Think about using both objective and subjective data to evaluate the effectiveness of the nursing actions. E.g.

· Giuseppe is able to wash and dress himself within minimal breathlessness.

· Giuseppe is able to take the stairs with minimal breathlessness after using bronchodilators.

(You should expand each point with support of the literature evidence.)

8. Reflection – what you have learned from this process and what you could have done differently. E.g.

Next time, I would…

I should have …

If I had…

I now understand…

Here are a few examples:

· I now understand the effects of COPD in limiting ability to carry out ADL.

· If I had more knowledge of COPD I would understand the impact on the patient’s ability to undertake their ADL.

· I now understand the effects of long term smoking on lungs.

(You should expand each point with support of the literature evidence.)

CONCLUSION: (175 words approx.)

· In several sentences summarise what you have discussed. – THIS IS NOT A REPEAT of what you have written previously.

· Then provide overarching statements that provide the reader with the most important take-home messages regarding the care plan for your client.

Useful tips: The introduction and the conclusion need to be written AFTER the content has been written, not before.

REFERENCES (12-15 references approx.) Two key references must be included:

Hunter, S. (Ed). (2016). Miller’s nursing for wellness in older adults (2 nd Australia and New Zealand ed.) North Ryde, NSW: Lippincott, Williams and Wilkins.

Levett-Jones, T. (Ed.). (2013). Clinical reasoning: Learning to think like a nurse. Frenchs Forest, NSW: Pearson.


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